HomeMy WebLinkAboutMiscellaneous - 1 HIGH STREET 4/30/2018 (5)7�;
01 -
Date ... ........
N2 -j 5 , 3' "1" ... If
0 TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SAC$4US
This certifies that ...... /;. T ......... ..............................................
......................
'17 has permission to perform .......... ....................................
-nng in the building of ....... ................ .................................................
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........ .............................................. .............. North Andover, Mass.
Fee.................. ... Lic. No . ........... i� -� ............. ........... I ........... I ........................
ELECTRICAL INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. J
/0
Occupancy and Fee Checked
[Rev. 11/99] leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL LVF�O/� TION) Date: / � - ;L6 - O/
Cityor Town of: A)jl R �` odewIc- To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electricalwork described below.
Location (Street & Number) �i.G j/ S%. /�L -A .V 15/ T �
Owner or Tenant
Owner's Address
Telephone No. 77�'� 4/-/-7.
Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Installation of Burglar Alarm
No. of Recessed Fixtures
--- - -.. _ ..._ ..... -
No. of Ceil: Susp. (Paddle) Fans
...,,.,... t. uu eeeur u rrrres.
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA.,
No. of Lighting Fixtures
Swimming Pool Above ❑ In- ❑
o. o mergence Lighting
rnd. rnd.
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
I No. of Zones
No. of Switches
No. of Gas Burners
No. o an
Initiatin tinRon
Deices
�. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
b
10. of Waste Disposers
Beat Pump
Number
— -
Tons
---...__
W
'"""
No. oSelf-Contained
Totals:
Detection/Alertina Devices
No. of Dishwashers
Space/Area Heating KW
Local ElMunicipal El Other
Connection
No. of Dryers
Heating Appliances KWf!
sste :
--No
No. o Water K`�,
No. of No. of
- vices or Equivalent
Data Wiring:
Heaters
Signs Ballasts
No. of De-ices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications inng:
No. of Devices or Equivalent
OTHER:
.-,uac,l uucuuu.ruI actin y aesn•ea, or as regwrea ov me mspeeto�• of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical «ork may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force. and has exhibited proof of same to the peril -it issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
(Expiration Date)
Estimated Value of Electrical Work: S ��. °� (When required by municipal police.)
Work to Start: Inspections to be requested in accordance with 1\1EC Rule 10, and upon completion.
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: ADT Security Services 111 Morse Street, Nonv�od 'AIA Q20,6127 :-NO.: 1533C
Licensee: John S. Bassett Signature O.:
(If applicable, enter " exemLIC. N1533C
pt " in the license nitniber line.). Bus. Tel. No.- 1 33 .1131
Address: ! Alt. Tel. No.: L6;Q
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement I am die (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: S